[Transition and future tasks of occupational health practice in small and mid-sized companies in the city of Sapporo].

OBJECTIVES: This study aimed to examine the present state of activities of occupational health physicians (OHPs) and companies' opinions about them. METHODS: Questionnaires, to be answered anonymously, were sent to 1,898 companies with ≥ 50 employees. We analyzed the data according to type of industry and the size of the company. RESULTS: We received 692 responses. First, we compared the data with the results of a previous study we had conducted in 2003. The percentage of companies that employed OHPs was found to have increased from 77% to 97%. The implementation rate of work place inspection conducted by OHPs had increased from 41% to 65%, and the attendance rate of health committees increased from 24% to 56%. Regarding overtime, we found that the percentage of workers who did more than 80 hours of overtime work per month had decreased from 29% to 7%, but in the transportation industry the high rate of 38% was maintained. Stress assessments were conducted by 98% of the companies with ≥ 50 employees. CONCLUSIONS: This study determined the present situation in companies, with regard to recent law revisions. Stress assessments are carried out more frequently, the number of workers doing overtime has decreased, and measures against second-hand smoke are being promoted. In addition, we found an increase in the frequency of work place inspection and attendance of health committees, but in one-third of the companies these were not carried out.

[Two cases of nonrecurrent inferior laryngeal nerve--different branching levels from vagus nerve].

We observed two cases of nonrecurrent inferior laryngeal nerve (NRILN). Case 1, a 71 year old man was diagnosed as having papillary carcinoma. NRILN was found during his operation. It directly branched from the right cervical trunk of the vagus nerve at the level of the cricoid cartilage and then entered the larynx after running behind the thyroid gland. Case 2, a 64 year old woman was diagnosed as having primary hyperparathyroidism. In this patient, the NRILN branched at the level of the inferior pole of the thyroid gland, rose up beside the tracheal wall and entered the larynx. In both patients, preoperative CT scan and postoperative MR angiography revealed the aberrant right subclavian artery. A postoperative barium swallow test showed the compression of the esophagus by this anomalous artery in case 1. Although it is possible to predict the presence of NRILN by preoperative imaging tests, the branching level from the vagus nerve is unpredictable. Surgery must be performed with this point in mind, if the presence of NRILN is suspected.